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Written by: Darlene D'Altorio-Jones (1959-2015) on Saturday, December 10, 2011 Posted in: Inpatient Rehab

What happens when a particular health care issue requires the direction of health professionals to direct, monitor and provide the needed information to specifically guide therapy outcomes because circumstances could lead to harmful or unsuccessful recovery in the absence of that assistance? Very often, therapy services are sought in many post acute care (PAC) levels of service.

Therapy provided in PAC is demanding further attention. As health care transformation evolves, it is more evident that keeping persons out of facilities and managing their own health will grow ever more popular to meet specific recovery to maintain function. Whether services were provided in outpatient or other post acute care settings, predominantly four health care procedural terminology codes (therapeutic exercises, manual therapy, therapeutic activities and neuro-muscular re-education) dominated the top services provided as noted in a study by RTI International, Therapy Utilization Report completed in 2007.

Taking into account that Medicare Beneficiaries are expected to climb at an alarming rate from 39 million to 79 million between 2000 and 2030 according to a Kaiser Family Foundation Fact Sheet, finding payment alternatives, types of services, and most effective procedures for various health care ailments must occur rapidly! Analyzing effectiveness and costs naturally fall in line.

Health care professionals more than ever must increase awareness of the effectiveness and the costs of care provided so that redundant non-effective treatment is written out of practice and only the most advantageous types of care are retained. It’s a difficult task because procedural terminology defines a broad spectrum of therapeutic interventions. And no matter where practiced in the various PAC settings; top use of procedural codes concentrated to four to five major areas without clear definition of exactly what technique is practiced when dropping those codes is alarming. It demands more discrete data aggregation and few providers are gathering the type of data needed.

The various studies that RTI and Medicare have recently embarked upon (C.A.R.E. TOOL and DOTPA) are two studies that hope to increase awareness and further guide direction for payment and level of services required for PAC.

Outpatient services alone for Medicare Part B covered individuals equated to approximately 3.5% of Medicare spending in 2007, with costs at $4.37 billion for more than 140 million claims filed that calendar year per RTI International. With those types of costs and expected growth, those that direct and manage therapy services should turn greater attention to quality of care and accomplishing goal objectives in the most cost-effective manner. Why? Because fee for service is a term quickly being abandoned in payment methodologies with pay for performance and prospective payment mounting ever more rapidly.